Tuberculosis in Children

from adolescent/adult
Inhalation
INCUBATION
Apex Kidneys
x x
Meninges Liver
x x Immune Response
Bone Peritoneum
x x
DISEASE
Pneumonia Endobronchitis
Miliary TB
HEALING
Adolescent/
Adult Long Latent Phase
1
INHALATION
1. Coughing
Airborne
2. Sneezing droplet
3. Talking
Adult/adolescent Pulmonary (Open) TB

Asymptomatic/symptomatic
Adult/adolescent becomes non-communicable 3 weeks

after standard treatment is started
2
INCUBATION
6-8 weeks earliest
Average of 2-3 months
3
INFECTION
PPD test starts to be with POSITIVE skin test
1. TB Bacilli are Blood Borne to:

1. Meninges 4. Spleen
2. Peritoneum 5. Lungs
3. Liver 6. Bones
2. Immune Response Development to the Infection
3. Multiorgan Distribution of TB Bacilli are suppressed
4. Hilar (Primary) Infection persists

Area of caseation limited by immune response
Drained by adjacent lymph nodes
4
TB DISEASE
1. Hilar Caseation
2. Enlarged adjacent lymph nodes
3. Positive PPD
4. Symptoms:
a. Fever more than 2 weeks
b. Cough, wheezing
c. Anorexia failure to respond to antibiotics >2 weeks
d. Weight loss after recovery from illness
e. Decrease physical activities
5. Positive Serologic Test
6. Sputum may be positive
5
CRITERIA FOR DIAGNOSIS (DOTS)
1. Hx of Exposure
2. Positive PPD
3. Signs and Symptoms of Disease
4. Primary Complex on X-ray
5. Positive Serologic Test for TB or Sputum Positive (done 3x)
3 out 5 criteria qualifies for DOTS
6
PRIMARY COMPLEX LOCAL SPREAD
Characterized by:
1. Enlarging area of caseation
2. Endobronchial disease
3. TB Pneumonia
7
PRIMARY COMPLEX LOCAL SPREAD
1. Enlarging area of caseation

Seen on x-ray with lymph node enlargement
2. Endobronchial disease
Inflammation and caseation on top of bronchus
Bronchial compression with wheezing
Bronchial erosion
Atelectatic distal bronchial branch
Febrile, symptomatic disease
8
TB PNEUMONIA
Breaks/erosion of caseous material
Seeding of TB into distant bronchial portions
Further spread of TB lesions
May lead to TB Pneumonia
Febrile/typhoidal temperature
Cough, fever, dyspnea
9
EXTRA-PULMONARY TB
Miliary TB
Failure of immune suppression of previous hematogenous
spread
Average incubation about 18 months from uncontrolled

primary TB infection
Miliary size caseation on all organs affected
Miliary lesion seen on chest X-ray

Hypatomegaly
Spleenomegaly
Ascitis / peritonitis
Meningitis in 33%
Pneumonia
10
TB Meningitis
Stage I
Build up of Intra-Cranial Pressure (ICP)
CSF protein and settle at basal area
Optic chiasm compression

Headaches and squinting
Decrease physical interest and activity
Fever and mild neurologic deficit
CSF pressure
protein
WBC and lymphocytes
CSF sugar
At least 25% neurologic sequelae with optimal treatment
11
TB Meningitis
Stage II Progression from Stage I

Convulsions
Sersorium
50-75% neurologic sequelae with optimum treatment
Stage III Progression from Stage II

Sustained convulsions
Decerebrate rigidity
100% neurologic sequelae
Death from neurologic deterioration

Aspiration pneumonia
Compression ulcers
Cerebral herniation
Status epilepticus 12
EXTRA-PULMONARY TB
TB of the Bones
1. Pott's Disease average early onset 5 years from 1 TB
2. Hip joint
3. Knee, etc.
Renal TB average onset is 15 years

= "sterile" pyuria
Other sites:
Cervical nodes (scrofula)
ENT
Skin
Eyes - conjunctivitis
13
TREATMENT
I. Exposure
No S&S
PPD negative
Living with source
1. Treat source
2. INH 3 mos.
3. PPD after 3 mos. (-) stop
=3H
II. TB Infection (latent)

Exposure
No S&S
PPD positive
=9H
14
TREATMENT
III. TB Disease
2 HRZ 4 HR or 6 HE
TB Meningitis
2 HRZS 4 HR
Miliary / Bone
2 HRZS 10 HR
Relapse or Interrupted Tx
2 HRZES/HRZE 5 HRE
15
Congenital TB via Placenta
Pulmonary TB of mother
Genital TB
Baby S&S develop anytime in 4-6 weeks
I. Hepatic 1 lesion
fever, jaundice
II. Pulmonary 1 lesion
fever, cough, dyspnea
2 HRZS 4-7 HR
16
Mother with TB delivers a newborn baby
Treat baby as a case of exposure
3 H PPD
negative positive, chest x-ray negative

stop 9H
BCG
17
from adolescent/adult
Inhalation
INCUBATION
Apex Kidneys
x x
Meninges Liver
x x Immune Response
Bone Peritoneum
x x
DISEASE
Pneumonia Endobronchitis
Miliary TB
HEALING
Adolescent/
Adult Long Latent Phase
18

Tuberculosis in Children

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Tuberculosis in Children

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from adolescent/adult

Adult/adolescent Pulmonary (Open) TB

Adult/adolescent becomes non-communicable 3 weeks

6-8 weeks earliest

Average of 2-3 months

PPD test starts to be with POSITIVE skin test

1. TB Bacilli are Blood Borne to:

2. Immune Response Development to the Infection

3. Multiorgan Distribution of TB Bacilli are suppressed

4. Hilar (Primary) Infection persists

2. Enlarged adjacent lymph nodes

5. Positive Serologic Test

6. Sputum may be positive

3. Signs and Symptoms of Disease

4. Primary Complex on X-ray

5. Positive Serologic Test for TB or Sputum Positive (done 3x)

3 out 5 criteria qualifies for DOTS

1. Enlarging area of caseation

1. Enlarging area of caseation

Breaks/erosion of caseous material

Seeding of TB into distant bronchial portions

Further spread of TB lesions

May lead to TB Pneumonia

Cough, fever, dyspnea

Average incubation about 18 months from uncontrolled

Miliary size caseation on all organs affected

Miliary lesion seen on chest X-ray

Optic chiasm compression

Stage II Progression from Stage I

50-75% neurologic sequelae with optimum treatment

Stage III Progression from Stage II

100% neurologic sequelae

Death from neurologic deterioration

Renal TB average onset is 15 years

II. TB Infection (latent)

negative positive, chest x-ray negative

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